后颅窝骨性扩大术治疗Chiari畸形合并脊髓空洞症

目的　介绍后颅窝骨性扩大术治疗Chiari畸形合并脊髓空洞症。方法　该手术分为两种亚术式 ,一种是枕颈固定扩大术 :取自体髂骨 5cm× 10cm ,打磨成“凹”字形。上端为齐头端 ,固定在后颅窝减压窗缘。缺口端为下端 ,固定在枢椎棘突上 ,将扩大的硬脑 (脊 )膜修补筋膜片固定在植骨片内面 ,使筋膜片贴附在植骨片内面 ,形成帐篷状 ;另一种是单纯骨性扩大术 :取自体髂骨 6cm× 8cm的梯形骨片 ,并利用较厚的髂骨缘打磨成弧形。植骨片固定在后颅窝减压窗上 ,弧形端构成枕骨大孔后缘。将扩大的硬脑 (脊 )膜修补筋膜片也固定在植骨片内面 ,使筋膜片贴附在植骨片内面 ,也形成帐篷状。结果　本组病例随访 2～ 7年 ,术后症状体征缓解总有效率为91.6% ,肌力比以前提高 2～ 3级。结论　该术式比其他治疗Chiari畸形合并脊髓空洞症的术式 ,治疗效果显著 ,疗效切实可靠     

Use of the KTP-532 Laser in Acoustic Neuroma Surgery

The potassium titanyl phosphate (KTP-532) laser has been applied to otologic surgery with a proven record of both safety and efficacy. The aim of this study was to demonstrate the use, safety, and advantages of laser dissection in the surgical treatment of acoustic neuromas. The authors' experience with 111 patients in whom laser surgery was used in acoustic neuroma is presented, with emphasis on surgical technique employed and facial nerve functional outcome. The method of laser dissection did not result in deleterious neurologic sequelae or laser-specific complications. In addition, laser dissection afforded certain advantages to traditional techniques, especially in larger tumors. The facial nerve functional outcome as assessed by the House-Brackmann grading system revealed that 90.2% of small tumors, 72.2% of medium tumors, and 75.0% of large tumors achieved satisfactory (grades I and II) functional results. These results compare favorably with the literature describing nonlaser dissection techniques. The observations and results reported in this article demonstrate the safety of the KTP-532 laser in the posterior cranial fossa, and specific advantages that this technology may offer to the surgical armamentarium of the neuro-otologist are outlined.     

Primary pleomorphic adenoma in posterior cranial fossa

A 35-year-old woman had an intradural tumor in the posterior fossa adjacent to the posterior wall of the left pyramidal bone, which was totally removed and histologically diagnosed as a pleomorphic adenoma. Follow-up examination for 2 years showed no recurrence of the tumor. There was no primary lesion in any other gland of the body, and therefore there is no alternative but to conclude a “migration” of some gland cells. The pathogenesis of this tumor remains unclassified.     

MRI of the brain in cerebrotendinous xanthomatosis (van Bogaert-Scherer-Epstein disease)

The clinical, biochemical and magnetic resonance imaging findings of two patients with cerebrotendinous xanthomatosis are reported. This is a rare hereditary disease. Early recognition of this entity is important in view of the existing treatment possibilities. Magnetic resonance imaging findings typically include a bilateral and almost symmetrical increase of the signal intensity on the T2-weighted images in the cerebellar and periventricular cerebral white matter, the basal ganglia, the dentate nuclei and the brainstem as well as cerebellar and cerebral atrophy. Received: 18 January 1999; Revised: 3 June 1999; Accepted: 7 June 1999     

不同丙烯酸材料的人工晶状体对后发性白内障的影响

目的 探讨三种不同的丙烯酸材料的人工晶状体应用于白内障超声乳化吸除联合人工晶状体植入术后对后发性白内障的影响作用.方法 超声乳化白内障吸除联合人工晶状体植入术的960例白内障患者(964只眼),Sensar组310只眼,Acrysof三片组332只眼,Acrysof一片组322只眼,术后定期随访18～28个月,观察视力、后发性白障的发生情况.结果 术后随访24月时,发生1级以上后囊膜混浊SensarIOL组的发生率(13.5%),明显高于Acrysof一片式IOL组及Acrysof三片式IOL组的发生率(7.5%,3.7%).经卡方检验,P值均<0.05,有显著性差异,而Acrysof三片式IOL组后囊膜混浊的发生率较Aerysof 一片式IOL组高,P<0.05.结论 AcrySof丙烯酸式一片式人工晶状体植入后出现后发性白内障的发生率在三组中最低.可以减少后发性白内障的发生降低Nd:YAG激光的使用率,提高手术效果,是现代白内障手术可选择的理想的人工晶状体.     

糖冠康胶囊对糖尿病性冠心病大鼠缺血心肌保护作用的研究

目的:探讨糖冠康胶囊对糖尿病性冠心病大鼠急性缺血心肌的保护作用机制.方法:将大鼠随机分为空白组及丹参对照组,将四氧嘧啶性糖尿病大鼠随机分为5组:分别为模型组,美吡达组,糖冠康胶囊高,中,低剂量组.大鼠灌胃4周后,制作垂体后叶性急性心肌缺血模型,测定各组大鼠血糖、血脂、血清胰岛素、糖化血清蛋白及心电图的改变.结果:糖冠康对糖尿病性冠心病大鼠具有明显的降血糖、降血脂作用;明显对抗T波及ST段的升高;明显降低心肌酶的大量释放.结论:实验研究证明,糖冠康胶囊对糖尿病性冠心病心肌缺血有保护作用.     

Long‐term Radiological and Clinical Outcome after Lumbar Spinal Fusion Surgery in Patients with Degenerative Spondylolisthesis: A Prospective 6‐Year Follow‐up Study

ObjectiveTo assess which radiological alignment parameters are associated with a satisfactory long‐term clinical outcome after performing lumbar spinal fusion for treating degenerative spondylolisthesis.MethodsThis single‐center prospective study assessed the relation between radiological alignment parameters measured on standing lateral lumbar spine radiographs and the patient‐reported outcome using four different questionnaires (COMI, EQ‐5D, ODI and VAS) as primary outcome measures (level of evidence: II). The following spinopelvic alignment parameters were used: gliding angle, sacral inclination, anterior displacement, sagittal rotation, lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Furthermore, the length of stay and perioperative complications were documented. Only cases from 2013 to 2015 of low‐grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) were considered. The patients underwent open posterior lumbar fusion surgery by pedicle screw instrumentation and cage insertion. The operative technique was either a posterior lumbar interbody fusion (PLIF) or a transforaminal lumbar interbody fusion (TLIF) performed by three different senior orthopedic surgeons. Exclusion criteria were spine fractures, minimally invasive techniques, underlying malignant diseases or acute infections, previous or multisegmental spine surgery as well as preoperative neurologic impairment. Of 89 initially contacted patients, 17 patients were included for data analysis (11 males, six females).ResultsThe data of 17 patients after mono‐ or bisegmental lumbar fusion surgery to treat low‐grade lumbar spondylolisthesis and with a follow‐up time of least 72 months were analyzed. The mean age was 66.7 ± 11.3 years. In terms of complications two dural tears and one intraoperative bleeding occurred. The average body mass index (BMI) was 27.6 ± 4.4 kg/m² and the average inpatient length of stay was 12.9 ± 3.8 days (range: 8–21). The long‐term clinical outcome correlated significantly with the change of the pelvic tilt (r _s = −0.515, P < 0.05) and the sagittal rotation (r _s = −0.545, P < 0.05). The sacral slope was significantly associated with the sacral inclination (r _s = 0.637, P < 0.01) and the pelvic incidence (r _s = 0.500, P < 0.05). In addition, the pelvic incidence showed a significant correlation with the pelvic tilt (r _s = 0.709, P < 0.01). The change of the different clinical scores over time also correlated significantly between the different questionnaires.ConclusionsThe surgical modification of the pelvic tilt and the sagittal rotation are the two radiological alignment parameters that can most accurately predict the long‐term clinical outcome after lumbar interbody fusion surgery.     

后路腰椎椎体间融合术后融合器脱出的危险因素分析

【摘要】 目的：探讨腰椎椎体间融合内固定术后融合器脱出（cage retropulsion,CR）的危险因素。方法：回顾性分析2017年9月~2021年9月在我院因腰椎椎体间融合内固定术后CR行翻修手术的17例患者,其中男13例,女4例,年龄63.7±9.9岁,纳入CR组。根据相同的融合及固定节段、初次手术时间（±1年）、性别、年龄（±2岁）在无融合器脱出及移位的患者中按照2∶1的比例进行配对共匹配34例作为对照组,其中男26例,女8例,年龄65.2±10.2岁。CR组初次手术平均固定节段数为1.8±0.8个,融合节段数为1.5±0.6个;发现CR距离初次手术时间为7个月（0.75~132个月）;17例患者中单个节段CR 15例,两个节段CR 2例。在两组患者术前全脊柱X线片上测量腰椎前凸角（lumbar lordosis,LL）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）、骨盆入射角（pelvic incidence,PI）、腰椎侧位X线片上测量病变节段椎间高度（disc height,DH）、屈伸位X线片上测量椎间隙活动度（range of motion,ROM）;通过术前腰椎CT检查测量腰椎椎体CT值;通过腰椎MRI检查定义椎间盘形态;在术后即刻腰椎X线片上测量融合器位置（融合器后缘标记线到下位椎体后上缘的距离与下位椎体上终板前后径的比值）。采用配对样本t检验的方法对两组间资料进行单因素分析,对单因素分析有统计学意义的参数进行Logistic回归分析,寻找CR的独立危险因素。结果：CR组椎体CT值小于对照组（124.8±39.7 vs 147.7±38.2, P=0.011）,术后即刻X线片上融合器位置较对照组更靠后（0.15±0.09 vs 0.31±0.07, P<0.001）;两组间术前LL（40.8°±12.9° vs 42.4°±7.5°,P=0.717）、PT（19.6°±7.1° vs 17.1°±6.7°,P=0.356）、SS（27.7°±6.5° vs 31.0°±4.3°,P=0.144）、PI（44.3°±13.8° vs 44.7°±13.9°,P=0.926）、DH（10.1±2.4mm vs 8.8±1.4mm,P=0.066）、ROM（4.3°±2.8° vs 4.4°±2.2°,P=0.950）、梨形椎间盘比例（33.3% vs 21.4%,P=0.40）均无统计学差异。Logistic回归分析结果提示椎体CT值低（骨质疏松）（OR=0.975,P=0.043）和融合器位置靠后（OR=28.393,P=0.003）是CR的独立危险因素。结论：骨质疏松与融合器放置靠后是后路腰椎椎体间融合术后CR的危险因素。     

后交叉韧带损伤MRI诊断指标的评价

目的评价后交叉韧带(PCL)损伤各种MRI征象的诊断价值。资料与方法分析32例经关节镜或临床诊断的PCL损伤患者MRI资料,并与57例非PCL损伤病例对照,总结PCL损伤直接和间接征象,依据各征象建立回归模型。结果正常PCL可分为"弓"形、"U"形、和"打结"形3种形态。根据PCL损伤征象建立的回归模型,其诊断的重要程度依次为PCL消失、不连续,PCL信号异常,内侧副韧带损伤,PCL增粗,三角间隙积液以及骨挫伤。结论MRI是诊断PCL损伤的重要手段。PCL损伤各征象对诊断的重要性不同,以此建立的回归模型有较强的预测能力。